The tolerance of aggression

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Workplace violence is a major problem in healthcare, with staff in many institutions feeling it is an inevitable part of the job. HRMR asks what can be done to change this culture of acceptance.

One of the major findings of Jeff Natterman’s analysis of the 2010 shootings at Johns Hopkins Hospital was that hospital staff had come to accept workplace violence as an inevitable part of the job.

These findings were echoed in a 2011 white paper by the ASIS Healthcare Security Council, which stated that as many of 50 percent of verbal and physical assaults by patients on nurses went unreported.

The reasons for failing to report these distressing occurrences are complex: empathy for patients and family members, fear or retaliation, concern that reporting an event could affect customer service scores, and anxiety that employers might somehow see the nurse as to blame in the incident, were all given as reasons for remaining silent.

Chair of the ASIS healthcare council Dean Sobcoviak believes that violence in healthcare is a growing problem. He says one of the major contributory factors is the culture of tolerance that exists in the majority of hospitals.

“Patient generated violence continues to rise—I believe that to be one of the biggest challenges that we have today,” he says. “I think many healthcare workers who work specifically in the emergency department setting historically have felt that it is simply a part of the job—because they work in such a dynamic environment with many people who are obviously physically injured but also sometimes mentally ill it’s just something they have to accept.

“Also there has historically been a lack of support from the hospital—but also from the legislation. Staff have not been supported when reporting acts of violence against them, and we’re talking a wide range of violence too, from intimidation and verbal abuse all the way through to physical assault.”

AT RISK IN HEALTHCARE

Kevin Wilkes, practice leader for Willis Security Risk Consulting, agrees that violence is a hot issue in healthcare, which is considered to be an at-risk industry. He says that more than 45 percent of non-fatal assaults at work occur against employees in the healthcare industry.

“While the overall number of workplace violence fatalities has been on the decline for the past 10 years there are still more than two million American workers who are victims of violent crime in the workplace each and every year.”

According to the Occupational Safety in Health Administration (OSHA), workplace violence has become the fourth most prevalent cause of death in the workplace. “It’s also the leading cause of death among women at work, and as you can imagine the caregivers in the healthcare industry are still primarily women,” Wilkes says.A 2011 Emergency Nurses Association survey found that 54 percent of emergency nurses surveyed had experienced physical violence and/or verbal abuse from a patient and/or visitor during the previous seven calendar days. Echoing the findings of the ASIS report, it also found that the majority of these victims of workplace violence did not file a formal report for the physical violence or the verbal abuse that they experienced.

Why is violence so common in healthcare? Wilkes puts it down to a steady increase in rates of crime due to poor economic conditions, the accessibility of drugs including narcotics and the volatile atmosphere that can develop around patients and visitors who are sometimes distraught because of a physical condition or the death of a loved one.

Sobcoviak believes economic conditions and resulting cuts in funding are of particular significance. “We’ve seen such a reduction in the available hospital beds for the mentally ill,” he says. “There’s been a reduction in funding and reimbursements and so we’re seeing a large increase in our emergency departments of people who are mentally ill. We also see an increase in waiting times and stress levels that are common when at a hospital—you add all those things together and you get people lashing out towards the care providers.” Wilkes says another factor is the ease of access into hospitals and clinics. “Traditionally healthcare facilities were considered to be open, inviting environments for guests and loved ones, but the ease of accessibility has become problematic,” he says.

Wilkes encourages his clients to increase their knowledge of the potential security or protection-related risks that can affect healthcare facilities, recognising that not all risk is created equal: some facilities have more risks or vulnerabilities than others. A large campus health clinic, for instance, may have more significant risks than a hospice, nursing home or assisted living facility.

CONTROLLING THE RISK

When addressing violence in healthcare Wilkes asks his clients to focus on three primary levels, or risk control areas: environmental controls—CCTV, intruder alarms and physical security that enhances the environmental protection; behavioral controls—what they have in place in terms of educating patients and staff; and administrative controls—the policies and procedures they have in place in terms of workplace violence prevention techniques and mandates that staff, patients and visitors will be expected to abide by and be held accountable to.

Sobcoviak paints a similar picture. “There are several things we need to look at to improve. I think there needs to be better education and better commitment from administration and legislators; there need to be training programs and awareness for the staff, and I believe that there have to be effective programs in place where staff feel empowered not only to protect others around them but to protect themselves.”

In order to truly create change, he believes the culture of tolerance of violence against staff has to end; risk managers need to embrace that challenge and embrace the fact that there is a problem. In order to solve it, there needs to be a collaborative effort between everyone involved in the healthcare setting, from nursing staff and physicians to the service level employees.

“They need to take a stance that it is not OK to be verbally or physically abused by anyone,” he says. “It’s very important that we have training programs focused around that because we know in many cases we react to situations based on our past training and experience. There needs to be a zero-tolerance policy from the organization, and a commitment to a very specific program and training. I think those are key, along with encouraging the actual reporting so we’re comfortable that we’re getting really accurate information.”